Asthma Chronic Disease

Introduction

Asthma is a chronic disease that involves blocking the airway in the lungs. The airways become inflamed, swollen, and the muscles may tightenthe airwaymuscles to trigger the symptoms of asthma. Some of the most common symptoms of blocking airways include the shortness of breath,coughing, wheezing, and the chest tightness. The timing of the asthma symptoms is based on the physical activity of the patients. Healthy people can also acquire asthma while exercising thatis called the exercise-induced asthma. It is,therefore, important to keep yourself active to make the symptoms be under control. People with a family history of allergies have a high chance of developing asthma. The allergic asthma is mainly caused by occupational triggers such as dust, gasses, inhaling of fumes, and other harmful substances.

Symptoms of Asthma

The symptoms of asthma are brought by the asthma triggers. These include substances that irritate the lungs, causing the tightening of muscles such as chemicals, odors, respiratory infections, allergies, physical activity, and emotions (Holgate & Douglass, 2010). Others are drugs such as aspirin, sulfites, viral upper respiratory infections, and some environmental pollutants. Understanding of the triggers is essential in the management of the disease. In the United States alone, more than 25% of the people are already infected making it a burden.

Overview of the disease

The airway tubes carry air in and out of the lungs. The patients’ airways become inflamed, swollen, and sensitive. The airways,therefore, start reacting strongly to certain inhaled substances. The reaction of the airways causes tightening of the muscles andnarrowing the airways(Holgate & Douglass, 2010). As a result, less air starts flowing into the lungs. The cells in the airways produce less than usual mucus.Sometimes the asthma symptoms can be mild to go unnoticed by many people. It is important to get to the health care providers as you notice some of these symptoms. Treating the symptoms is important to prevent the progress of the disease.

Prognosis

The disease has no cure, but it is manageable to prolong life. Even in the instances when a person feels fine, the disease is still affecting the lungs and can flare up at any time. The current knowledge and technology have been vital in the management of the condition by following effective treatment plans. The patients can live normal lives without interruption of the disease if the effective management plans are in place(Holgate & Douglass, 2010).

Causes of asthma

The exact cause of the disease is not known, but scientists have attributed it to the interaction of both the environmental and genetic factors. These include family histories that increase the tendency of developing certain allergies. Others include childhood respiratory infections and exposure to the asthma triggers such as fumes and dust. The environmental factors include cold and living in unsanitary and overcrowded habitats. People at all ages are at risk of developing the disease as it starts mainly in childhood (Garcia-Algar, 2013). The risk factors are the eczema or allergies. However, more boys have been reported to have asthma compared to girls. But adult women have more cases than men.

Current literature: Epidemiology

Asthma is a global disease with recent global estimates indicating that more than 334 million people are infected. The burden of asthma disability is also very high. The figure estimates were from the global burden of disease study conducted between 2008 and 2010(Meltzer et al., 2011). The study indicates that 14% of children worldwide have a likelihood of developing asthmatic symptoms(Meltzer et al., 2011). The condition is becoming more common in middle and low-income countries though the factors for the increase in the asthma rates are not well understood. Environmental and lifestyle changes in these countries are responsible for the increase in the cases(Garcia-Algar, 2013).

The burden of asthma and disability is common in children and adolescents. The standardizedmeasurements of the proportion of the population with asthma have helped address the global burden of the disease. The prevalence of asthma has increased in the United States from 7.3% in 2001 to 8.4% in 2010(Meltzer et al., 2011). The prevalence was higher among the childrenthan adults and in the native persons, American Indians, and the black people. The surveillance data was both from the national and state levels. The national data included information on asthma self-management education, physician visits, hospitalizations, deaths, medication, activity limitation, as well as the school and work days lost.

The literature is based on estimations and does not have information on the exact mortality caused by asthma. Besides, it has no proven medication for the treatment of asthma, but drugs for prolonging life trough reduction of symptoms.Little information is available concerning the diseases in various countries because of limited studies.

Diagnosis of asthma

There are several diagnostic tests that are used for confirmation of asthma cases. The lung function test involves the use of a spirometer to check on the functioning of the lungs. It also measures the level of blowing out air to determine the functioning of the airways. The physical examination tests are also used to check for the signs of asthma such as a runny nose, swollen nasal passages, and eczema. The allergy tests are conducted to determine the specific allergies affecting the person and the broncho-provocation test for measuring the sensitivity of the airways(Holgate & Douglass, 2010). The diagnosis in children is different as the children may exhibit signs of other childhood conditions that resemble those of asthma. The most certain test is the lung function test, physical examination, and a thorough examination of the medical history of the patients. Most physicians have spirometers for early diagnosis of the condition. The results of having asthma are high if the person has ever experienced airway obstruction a condition that improved after the use of a bronchodilator. The methacoline breathing test is used to determine the degree of twitchiness of the airways. Besides, allergy blood tests and chest x-rays may be ordered for confirmation of the cases.

Treatment and management of Asthma

There are two approaches that can be used for the management of asthma. These include the pharmacological and non-pharmacological approaches

The pharmacological approach

The drugs for the treatment of asthma are divided into categories of rescue medications and controller medications

The controller medications include the inhaled corticosteroids,theophylline,long-acting beta-agonists,cromolyn among others(Holgate & Douglass, 2010). The inhaled corticosteroids help in the prevention and control of inflammation of the airway muscles. They are effective as they improve the symptoms and pulmonary function in the patients. They include budesonide, fluticasone, flunisolide,beclomethasone, and ciclesonide.Budesonide is the most recommended for the pregnantpatients because of its proven efficacy. The drug does not present the risk of teratogenicity in the early days of pregnancy. The inhaled corticosteroids have the side effects of oral candidiasis,dysphonia, and cough. The side effects can be reduced by advising the patients to exercise mouth hygiene.

The patients who do not show improvement after the use of inhaled corticosteroids are recommended to use theophylline. However, the drug is not recommended for adjunctive therapy.A low dose of the drug should be recommended for the pregnant patients as it has the side effects of palpitations,insomnia, and nausea.

On the other hand, the long-acting beta-agonists are used as an add-on therapy in the use of ICS(Garcia-Algar, 2013). They are safe in pregnant patients, but can increase the risk of death when used in immunotherapy. The common side effects of the drugs include tremor, palpitation, and tachycardia. Comolyn is also effective in asthma management though not recommended for the pregnant patients. The drug is effective than ICSs thus recommended as an alternative therapy for asthma patients. The use of these drugs involvesfetalevaluation not to interfere with the pregnancy. Sonography and serial ultrasound examinations are important in monitoring the fetal growth and activity in the asthma patients before recommending the drugs(Levy, Weller, Hilton & Levy, 2006).

The rescue medications include SABAs that are effective medication during pregnancy. The drugs are not associated with cases of preterm delivery or congenital malformations(Levy, Weller, Hilton & Levy, 2006).The control of asthma during pregnancy is crucial for the health of the fetus. However, some drugs can interfere with the growth. The patients should have adequate knowledge regarding the control and rescue medicines for their effective use. SABAs have an action of 3 to 5-minute onset. Some the side effects associated with their use include palpitations, tachycardia, and tremors. The other type of rescue medications includes the systemic corticosteroids for severe asthma and exacerbations. The physicians offer the guidelines for their effective use, especially during pregnancy. Additionally, the drugs are associated with low-birth weight infants and preeclampsia. The combination inhalers are given to patients to manage the asthma. The inhalers contain corticosteroids.

Non-pharmacological approach

The non-pharmacological approach to the management of asthma involves the non-drug therapies. Some people prefer the use of breathing techniques to cope with asthma attacks while others prefer the prevention of asthma triggers. Regular exercise, especially for the athletes is recommended as it helps keep fit and prevent the asthma symptoms. The common prevention and management techniques involve breathing exercises, sports,exercise, and complementary medicine, and diet,cessation of smoking and avoidance of the allergy triggers.The breathing exercises are many thus require the asthma patients to chooseaccording to their specific needs. Relaxation and breathing techniques such as yoga have been recommended for improving the well-being of the patients and preventingthe asthma symptoms. The breathing techniques that help the patients breathe calmly and in a controlled manner are effective in asthma management. However, the patients need adequate information on their use and posture to assume. The other techniques include pursed-lip breathing.

The sports and exercise are important as they help in improving the lung and heart capacity. The regular exercises increase the uptake of air to the lungs, especially the much-needed oxygen. Although physical activity is a trigger for asthma, regular exercises have been proven to reduce the symptoms of asthma. The exercise-induced asthma can be reduced by use of interval training patterns. It is crucial to use the reliever medication before exercise for quick reaction in people with asthma(Garcia-Algar, 2013).

Avoidance of the allergy triggers such as the dust mites, environmental pollutants, and animal fur play a significant role in reducing the risk of asthma attack and preventing the symptoms. People should undertake interventions of avoiding such triggers such as wiping floors, and using mite-proof mattresses. Some individual interventions are essential to prevent the asthma symptoms by use of specific spray and cleaning the surroundings(Levy, Weller, Hilton & Levy, 2006).

Cessation of smoking is important to reduce the sensitivity of the airways. Cigarette smoking deposits nicotine, tar, and other substances in the airways contributing to narrowing and increase in sensitivity. They also worsen the inflammation of the airway lining. The therapies offered by patients are used to help them quit smoking(Garcia-Algar, 2013).

Diet management is effective to prevent overweight and obesity that worsen the asthma. Losing weight through regular exercise is recommended to keep asthma symptoms under maximum control.Additionally, complementary medicine such as homeopathy and traditional Chinese treatments has been essential in the reduction of the sensitivity of airway and controlling the asthma symptoms.

Justification of Treatment Approach

The non-pharmacological approach to the management of asthma has been recommended because of lack of likelihood of side effects, unlike the pharmacological approach. Additionally,the non-pharmacological approach is a set of precautionary measures for the patients and people who are not infected to prevent an attack.They help the patients control and manage their specific cases. Additionally,a non-pharmacological approach can be used during pregnancy or breastfeeding as it does not have contraindications, unlike othermanagementoptions. Minimizing exposure to the environmentalallergensis the most critical step in preventing asthma attack or managing the patients. Therefore, theelimination of allergens in the environment should be an integral part of the asthma management plan. Drugs have not shownsignificant impact in the reduction of asthma mortality compared to the minimizing of environmental exposure that decreases the severity of attacks.

Referral

The patients are considered for a referral if the diagnosis is unclear, or there are indications of unexpected clinical findings. These include cyanosis and cardiac diseases. Other considerations for patient referrals include CXR shadowing, Persistent non-variable breathlessness, and prominent systemic features such as myalgia, fever, and weight loss.

Conclusion

The best method for management of asthma is the non-pharmacological approach. The approach can be used by any person, regardless of age or condition. It is effective for both the breastfeeding and pregnant women. Health promotion initiatives through health education are effective for prevention of the attacks. The public get information on prevention techniques through mass awareness campaigns. The cooperation of the health care agencies and the public can be critical in reducing the cases of asthma attacks by observing lifestyle changes and reducing exposure to the environmental allergens.Although the disease has no proven cure, it can be managed  to prevent the spread and prolong life.

References

Garcia-Algar.(2013). Prediction of Childhood Asthma Using Conditional Probability and Discrete Event Simulation.Int. J. Stats. Med. Res.. doi:10.6000/1929-6029.2013.02.03.2

Holgate, S., & Douglass, J. (2010).Asthma. Abingdon: HEALTH Press.

Levy, M., Weller, T., Hilton, S., & Levy, M. (2006). Asthma. London: Class Pub.

Meltzer, E., Blaiss, M., Nathan, R., Doherty, D., Murphy, K., &Stoloff, S. (2011). Asthma burden in the United States: Results of the 2009 Asthma Insight and Management survey. Allergy And Asthma Proceedings. doi:10.2500/aap.2011.32.3519